URETERIC COLIC

&
AUR
Pwavan B Praveen
Ureteric Colic

■ Important emergency in medical practice

■ Abdominal pain Occurs due to obstruction of urine flow in the
ureter
■ 50% of patients present between the ages of 30 & 50 yrs
■ Slight Male preponderance
Etiology

■ Caused by obstruction of the urinary tract

■ Renal Calculi - most common
■ Blood Clot
■ rarely Sloughed Renal Papilla
Anatomical Narrowings in ureter
Clinical Features
■ Colicky pain - shows pain-free interval
■ Pain radiates to groin/testicle/labium, but not to back of leg
■ Testis of the affected side may be drawn up
■ Profuse sweating and haematuria
■ Tenderness can be elicited over the renal angle
■ Previous history of similar colic, passage of stone with urine
■ Skiagraphy revealing the stone
■ Frequency of micturition and strangury
Investigations
■ Dipstick hematuria
■ Non contrast CT scan
■ Supplementary plain X Ray
Management

■ Emergency Setting
■ Elective Setting
Emergency Setting

1. CT scan to confirm diagnosis

2. Small stones in distal ureter are likely to pass spontaneously
3. Medical expulsive therapy (MET)
4. NSAIDs for pain relief
5. Temperature, pulse, blood pressure, WBC counts
6. Estimated GFR monitored
7. Frequency of episodes of pain observed
In patients requiring urgent treatment for pain:
■ In situ extracorporeal shockwave lithotripsy (ESWL).
■ Cystoscopy and insertion of a ureteric stent as a temporising
procedure
■ Primary ureteroscopic stone retrieval (Lasertripsy used now).
In a patient who is septic secondary to an obstructing urinary
tract calculus
■ Insertion of a percutaneous nephrostomy (PCN) under local
anaesthetic
■ Cystoscopy and insertion of a ureteric stent.
Elective Setting

■ Extracorporeal Shockwave Lithotripsy(ESWL)

■ Ureteroscopy
■ Percutaneous Nephrolithotomy(PCNL)
■ Open stone surgery
Medical treatment

■ High fluid intake: urine output of 2.5L in 24hr

■ Correction of dietary excesses of calcium and oxalate
■ After surgical removal antimicrobial prophylaxis should be
maintained for 3-12 months
Acute Retention of Urine

Causes
 Male
1. Bladder outlet obstruction
2. Urethral stricture
3. Acute urethritis or prostatitis
4. Phimosis
 Females
1. Retroverted gravid uterus
2. Bladder neck obstruction (rare)
 Both
1. Blood clot
2. Urethral calculus
3. Rupture of urethra
4. Neurogenic
5. Smooth muscle dysfunction with ageing
6. Faecal impaction
Clinical features
■ No urine for several hrs
■ Pain
■ Bladder: visible, palpable, tender, dull to percussion
■ Neurological causes excluded by checking reflexes in the
lower limb and perinatal sensation
Treatment

■ Catheterisation
■ Suprapubic puncture
■ Urethral instrumentation
References

■ Bailey and Love’s Short practice of Surgery

■ S.Das
Thankyou